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A National Perspective

Charlotte W. Lewis, MD, MPH; Jeffrey D. Carron, MD; Jonathan A. Perkins, DO; Kathleen C. Y. Sie, MD; Chris Feudtner, MD, PhD, MPH

Arch Otolaryngol Head Neck Surg. 2003;129:523-529.

Background  During the past 50 years, changes in the epidemiology of infectious diseases and the capabilities of medical technology have altered the indications for, and implications of, tracheotomy in children. Given the complexity of health care that these patients subsequently require, monitoring the performance of this procedure and patient outcomes across the diverse US health care system is warranted.

Objectives  To characterize children who received tracheotomies in 1997 and to determine whether disposition and mortality vary by region or health care system attributes.

Design  A nationally representative retrospective cohort drawn from an 80% sample of administrative hospital discharge records from all pediatric admissions in 22 states during 1997.

Participants  Patients aged 0 to 18 years who underwent tracheotomy.

Methods  The sampling scheme of the discharge records enabled the calculation of regional and national estimates and of age-stratified population-based rates of tracheotomies. Weighted descriptive statistical and Poisson analyses were performed.

Results  The 2065 tracheotomy procedures recorded in the Kids' Inpatient Database yielded a national estimate of 4861 tracheotomies performed in 1997. The mean length of hospital stay was 50 days, with a mean total facilities charge exceeding $200 000. The rate of tracheotomy was highest among infants and varied significantly across regions of the United States. Adjusting for other patient and health care system attributes, patients who received their tracheotomy in a children's hospital had half the risk of dying during the admission compared with patients who were cared for in a non–children's hospital. Hospitals that performed more pediatric tracheotomies had significantly lower mortality rates than hospitals with lesser case volume. Among patients who survived to discharge, those cared for in the Northeast were discharged to long-term care facilities at twice the rate of patients in the West. Children cared for in children's hospitals or in teaching hospitals were significantly less likely to be discharged to a long-term care facility.

Conclusions  Pediatric tracheotomy is associated with significant variation in rates and outcomes across the United States and across different hospital types. Further research to clarify the reasons for these associations is warranted.

From the Child Health Institute (Drs Lewis and Feudtner), Department of Otolaryngology–Head and Neck Surgery (Drs Carron, Perkins, and Sie), and Department of Pediatrics (Drs Lewis and Feudtner), University of Washington, Seattle; and the Craniofacial Center, Children's Hospital and Regional Medical Center, Seattle (Drs Lewis, Perkins, and Sie). Dr Carron is now with the Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson; Dr Feudtner, with the Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa. The authors have no relevant financial interest in this article.

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